No guarantee of a health overhaul bill at the end of a couple months of Democrats fighting each other

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Democrats could fight each other for a couple months over health care.

Once, it seemed like the absolute last resort for getting a health reform bill.

Now it looks like the only way.

Michelle Obama: First Lady in Action

Passing a Democratic-only overhaul plan is getting a serious look from a beleaguered White House - but for President Barack Obama, corralling his own fractious party to pass health legislation will be a lot harder than it sounds.

Aides to Obama made clear Wednesday that they will move ahead with health care legislation in the fall with or without Republican support - though later in the day, seemed to soften on that stance a bit and leave open room for negotiations for Republicans.

No matter which way they go, the White House and congressional Democrats face long odds, and no guarantee of a bill at the end of the process.

Obama could sidestep one problem - a Republican filibuster in the Senate — if he goes with a partisan bill and attempts to pass it through procedural maneuver known as reconciliation. But he may well find a long list of other challenges, both political and legislative:

— He would still need to referee sharp differences within the Democratic Party over the government insurance option - with moderates saying they can't support the government-run option and liberals saying they can't support a bill without it.

— Obama also has to convince Democrats in the House and the Senate to take a potential near-term hit in public opinion for pushing ahead with a bill many Americans aren't yet sold on.

— He would face a minefield of obstacles under the reconciliation process because opponents could strike anything from the bill that the Senate parliamentarian deems not directly related the budget. This could jeopardize some of the most popular reforms, including the insurance exchange and reforms such as prohibiting insurance companies from denying coverage based on a preexisting condition.

— He must contend with a skeptical public. According to the latest NBC News Poll, a majority of voters believe Obama's health care plan would cover illegal immigrants, launch a government takeover of health care and use tax dollars to fund abortions.

— And he could do damage to his image as a healer of Washington's partisan ways if he leaves Republicans behind. The White House tried to go on the offensive this week, saying it was recalcitrant Republicans who were forcing them to go the Democrat-only route.

The White House and congressional Democrats are expected to wait until at least mid-September before deciding to abandon the bipartisan Senate Finance Committee talks. Despite the discussion Wednesday of what might happen at that point, Obama, Senate Majority Leader Harry Reid (D-Nev.) and Senate Finance Committee Chairman Max Baucus (D-Mont.) reaffirmed their commitment to the bipartisan talks.

"I am absolutely confident we are gonna get a bill, and I hope it's bipartisan," Obama said Wednesday as he returned to the Oval Office.

"It is fair to say the White House and the Senate Democratic leadership still prefer a bipartisan bill, and neither the White House nor us has made any decision to pursue reconciliation yet," said Jim Manley, a Reid spokesman. "We will not make a decision to pursue reconciliation until we have exhausted efforts to pursue a bipartisan bill. But patience is not limited and we are determined to get something done this year."

Progressives, for their part, were thrilled Wednesday to hear the White House acknowledge what they have been howling about for months. Comments this week from Senate Minority Whip Jon Kyl (R-Ariz.) and Sen. Chuck Grassley (R-Iowa), one of the three Republican negotiators on the Finance Committee, proved that Republicans aren't interested in a compromise, advocates said.

"Seeing Democrats rally around the public option, while Republicans say they won't support reform even if there is no public option, is some of the best news we've had in a while," one leading health care advocate said.

First, Grassley said Monday that he might not vote a bill unless it received broad Republican support, even if it included everything he wanted.

Then Kyl reacted to what Democrats viewed as a major concession - Health and Human Services Secretary Kathleen Sebelius saying Sunday that the public option was "not essential" - by raising other concerns. He said consumer-owned insurance cooperatives, which have been proposed as an alternative to the public plan, were a "Trojan horse." He also voiced opposition to insurance reforms on preexisting conditions.

"We've always said that the best politics is based on the best policies that have the support of the American people; those are clearly the policies supported by the President and captured in the legislation passed by the four committees that have acted," said Richard Kirsch, campaign manager for Health Care for America Now, a liberal advocacy group. "When the Republican leadership makes it crystal clear that they have no interest in passing the legislation that the President was elected to deliver, the only course is to move ahead with the support of a majority in Congress."

Echoing liberal bloggers, Adam Green, co-founder of the Progressive Change Campaign Committee, said Reid should force the 60-member Senate Democratic caucus to vote against the filibuster, and then allow those opposed to the public option to vote against the final bill - a suggestion that would work only if Sen. Ted Kennedy (D-Mass.) and Sen. Robert Byrd (D-W.V.), who have both been ill, were able to make the vote.

"The next step should be putting the pressure on Harry Reid, telling him to forget about reconciliation and instead to demand that Senate Democrats unite behind cloture and give this President an up-or-down vote on his proposals," Green said.

The three Senate Republicans involved in the negotiations -- Chuck Grassley of Iowa, Olympia Snowe of Maine and Mike Enzi of Wyoming -- are facing attacks from the right and left: Liberals think they're watering down a far-reaching health-care bill, and conservatives think they may give Democrats bipartisan support for a left-leaning bill.

The conservative Club for Growth announced an ad campaign Wednesday telling the three Republicans "not to cave" to Democrats. The group -- which has made its name attacking moderate Republican incumbents in primaries -- is launching television commercials in the senators' home states as part of its $1.2 million buy aimed at defeating the bill.

"There's no harm in talking, but it's important for their constituents to know what's being discussed," Club President Chris Chocola said in a statement. "And we believe it is vital that these three Republican Senators do not cave-in to the far left, as three Republican Senators did to provide the winning margin for President Obama's failed 'stimulus' spending bill."

Chocola adds: "It's up to Sens. Grassley, Snowe, and Enzi to stand up for their constituents and hold the line against government-run healthcare."

Sen. Jim DeMint (R-S.C.), one of the most conservative members of the Senate, has been making similar suggestions on national TV this week.

"Any Republican that goes along with this idea of, 'Let's pass something in the Senate and send it to conference with the House,' is really betraying everything we're hearing right now from the American people," DeMint said on Fox News yesterday.

Still, the three senators insist they want to stay at the negotiating table with Democrats.

"If the Democrats choose to go it alone, their health care plan will fail because the American people will have no confidence in it," Enzi said in a statement.

Months ago, it looked as though Republicans and Democrats might be able to the bridge the divide. The public option was still a tension point, but not as heated as it is today. There was, and still is, broad agreement about some of the insurance reforms, particularly protecting policy-holders with pre-existing conditions. Baucus even talked about getting 70 votes in the Senate.

But both sides raised the temperature along the way. DeMint called health care reform Obama's Waterloo. Grassley, Enzi and Snowe faced blowback from their Republican colleagues whenever it appeared as though they might be getting close to a deal. Liberals reacted with outrage whenever a top Democrat suggested they might have to accept compromises, including on the public plan.

"The Republicans made this a litmus test," said Stan Collender, a budget expert, former Hill staffer and partner at Qorvis Communications. "They are looking at it as a major test of Obama. ... I am not sure there was ever anything you could have done to get them."

Beyond the political calculation, however, there were strong disagreements over policy. When lawmakers dug deeper in the negotiations, the divisions over the role of government and the marketplace were laid bare. Democrats have been pursuing a fundamentally government-driven solution -- with strong regulations, subsidies and a public insurance competitor. The majority of Republicans favor something more market driven, such as providing tax credits for individuals to purchase their own coverage.

"Democratic leaders find themselves all alone in support of a plan that will drive health care costs higher than ever, increase the federal deficit, slash Medicare, and let government bureaucrats make personal medical decisions that only patients and doctors should make," Boehner said in a statement. "The more the American people learn about this plan, the less they like it. It's time for President Obama, Speaker Pelosi, and congressional Democrats to scrap this costly plan, start over and work with Republicans on reforms that make health care more affordable and accessible."

Still, the alternative to going it alone is doing nothing, which most Democrats agree would be a disaster.

"Everyone prepare for a couple of months of Democrats fighting each other over a very important issue," said a Democrat strategist close to the health care negotiations.